Bleeding Outcomes Associated with Coronary Artery Bypass Graft Surgery and Recent Clopidogrel Exposure

Blais, Danielle; Zukkoor, Sarah M.; Hayes, Charles H.; Pickworth, Kerry K.; Porter, Kyle; Firstenberg, Michael S.

doi:10.1532/hsf98.20121101

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…The overall mortality rate in those who took clopidogrel up to the time of surgery was also higher. These findings were reflected in a retrospective analysis of CABG patients ( n = 715): a significant association was observed between bleeding and clopidogrel exposure within 5 days before surgery 315 …”

Section: Discussionmentioning

confidence: 89%

“…These findings were reflected in a retrospective analysis of CABG patients (n ¼ 715): a significant association was observed between bleeding and clopidogrel exposure within 5 days before surgery. 315 A meta-analysis of 12 studies reported that continuing antiplatelet therapy (aspirin and clopidogrel) until the time of cardiac surgery was associated with increased blood loss, but carried a low risk of surgical re-exploration for bleeding. 316 The authors concluded that in patients at a high risk of stent thrombosis, this may be acceptable.…”

Section: Evidence Summarymentioning

confidence: 99%

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Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

111

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Section: Discussionmentioning

confidence: 89%

Section: Evidence Summarymentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

111

View full text Add to dashboard Cite

show abstract

“…The findings of RCTs have been reflected in a recent retrospective analysis of CABG patients (n ¼ 715): a significant association was observed between bleeding and clopidogrel exposure within 5 days before surgery. 196 A recent meta-analysis of 12 studies reported that continuing antiplatelet therapy (aspirin, clopidogrel) until the time of cardiac surgery was associated with increased blood loss, but carried a low risk of surgical re-exploration for bleeding. 197 The authors concluded that in patients at a high risk of stent thrombosis, this may be acceptable.…”

Section: Clopidogrelmentioning

confidence: 99%

Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

678

316

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: The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work.

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Impact of prasugrel pretreatment and timing of coronary artery bypass grafting on clinical outcomes of patients with non-ST-segment elevation myocardial infarction: From the A Comparison of Prasugrel at PCI or Time of Diagnosis of Non–ST-Elevation Myocardial Infarction (ACCOAST) study

Dudek

Dziewierz

Widimský

et al. 2015

American Heart Journal

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Bleeding Outcomes Associated with Coronary Artery Bypass Graft Surgery and Recent Clopidogrel Exposure

Abstract: Clopidogrel exposure within 5 days of CABG is associated with an increased risk of major bleeding.

Cited by 4 publications

References 22 publications

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe perioperative bleeding

Impact of prasugrel pretreatment and timing of coronary artery bypass grafting on clinical outcomes of patients with non-ST-segment elevation myocardial infarction: From the A Comparison of Prasugrel at PCI or Time of Diagnosis of Non–ST-Elevation Myocardial Infarction (ACCOAST) study

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